title: Development and psychometric properties of a scale for measuring internal participation from a patient and health care professional perspective.
abstract: BACKGROUND
  Effective patient-centred health care requires internal participation, which is defined as interprofessional patient-centred teamwork. Many scales are designed for measuring teamwork from the perspective of one type of health care professional (e.g. physician or nurse), rather than for the use for all health care professionals as well as patients. Hence, this paper's purpose is to develop a scale for measuring internal participation from all relevant perspectives and to check its psychometric properties.
  
  
  METHODS
  In a multicentre cross-sectional study, a 6-item Internal Participation Scale (IPS) was developed and administered to 661 health care professionals (staff) and 1419 patients in 15 rehabilitation clinics to test item characteristics, acceptance, reliability (internal consistency) and construct validity. Additionally, we performed an exploratory factor analysis (EFA) to determine the factorial structure and explained variance. Confirmatory factor analysis (CFA) was used to verify the theoretically assumed one-dimensional factorial structure.
  
  
  RESULTS
  A total of 275 health care professionals and 662 patients participated, and the complete data sets of 272 staff members and 536 patients were included in the final analysis. The discrimination index was above .4 for all items in both samples. Internal consistency was very good, with Cronbach's alpha equalling .87 for the staff and .88 for the patient sample. EFA supported a one-dimensional structure of the instrument (explained variance: 61.1% (staff) and 62.3% (patients)). CFA verified the factorial structure, with the factor loadings exceeding .4 for five of six items in both samples. Global goodness-of-fit indices indicated a good model fit, with a Tucker-Lewis index (TLI) of .974 (staff) and .976 (patients) and a comparative fit index (CFI) of .988 (staff) and .989 (patients). The root mean square error of approximation (RMSEA) amounted to .068 for the patient sample and .069 for the staff sample. There is evidence of construct validity for both populations.
  
  
  CONCLUSIONS
  The analysis of the scale's psychometric properties resulted in good values. The scale is a promising instrument to assess internal participation from the perspective of both patients and staff. Further research should investigate the scale's psychometric properties in other interprofessional health care settings to examine its generalizability as well as its sensitivity to change.
authors.affiliation: Medical Psychology and Medical Sociology, Medical Faculty, University of Freiburg, Hebelstr, 29, 79104 Freiburg, Germany. mirjam.koerner@mps.uni-freiburg.de.
authors.forename: Mirjam
authors.initials: M
authors.lastname: Körner
authors.forename: Markus A
authors.initials: MA
authors.lastname: Wirtz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003299:Cooperative Behavior; D003430:Cross-Sectional Studies; D003657:Decision Making; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D010358:Patient Participation / Q000523:psychology* / Q000706:statistics & numerical data; D018802:Patient-Centered Care; D010817:Physician-Patient Relations; D011594:Psychometrics; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D055815:Young Adult